CODE OF ETHICS ASS.pptx

1. CODE OF ETHICS
PRESENTED BY:
M.ASVINI
MSC NURSING 1ST YEAR
STUDENT
COLLEGE OF NURSING MMC,
CHENNAI

2. INTRODUCTION
Nurses are responsible to provide
their clients/patients with the high- quality
care. They are undoubtedly confronted with
various ethical challenges in their
professional practice, so they should be
familiar with ethical codes of conduct and
the essentials of ethical decision making.

3. DEFINITION OF ETHICS
Ethics are rules or principles that
govern conduct and are designed to protect
the rights of human being.

4. DEFINITION OF CODE OF
ETHICS
A code of ethics is a set of ethical
principles that are accepted by all member
of a profession.

5. NURSING ETHICS
It is branch of applied ethics that
concerns itself with activities in the field of
nursing.

6. NEED OF CODE OF ETHICS
 Helps professional practice ethically
 Helps identify ethical issues
 Protect the patient rights and dignity
 Guide for a professional behaviour
 Helps planning the education

7. PRINCIPLES OF CODE OF
ETHICS
 Autonomy :Right to health care decision
 Justice : fair with all people
 Fidelity: duty of an individual to be faithful to
the commitment made to himself.
 Veracity: The duty tell the truth
 Beneficence: Doing good for the client
 Malaeficence: Do not harm to the client

8. INTERNATIONAL CODE OF NURSING
ETHICS (THE ICN CODE OF
ETHICS FOR NURSES)
 Adopted in 1953 (ICN)
 Nurses have four fundamental
responsibilities
 The need for nursing is universal
 Respect for human rights
 Nurses render coordinated health services

9. THE ICN CODE OF ETHICS FOR NURSES
NURSES AND PEOPLE :
 Primary responsibility is to provide nursing
care
 Ensures that client receives sufficient
information
 Protect vulnerable populations
 Protect the natural environment

10. THE ICN CODE OF ETHICS FOR NURSES
Nurse and practice
 Responsibility and accountability for nursing
practice
 Competence by continual learning
 Maintains standards of personal conduct
 Provide technology and scientific advances
 Participate in research

11. THE ICN CODE OF ETHICS FOR NURSES
Nurses and the profession
 The major role in determining and
implementing acceptable standards
 developing a core of research- based
professional knowledge

12. THE ICN CODE OF ETHICS FOR NURSES
NURSES AND CO-WORKERS
 The nurse sustains a co-operative
relationship with co-workers
 The nurse takes appropriate action to
safeguard individuals, families and
communities

13. THE ICN CODE OF ETHICS FOR NURSES
NURSES AND SOCIETY
o Participate and share responsibility with
other citizens & other health professionals
o Aware of laws and regulations which affect
the practice of medicine and nursing.

14. CODE OF PROFESSIONAL
CONDUCT
1. Professional responsibility and accountability:
Nurse:-
 Appreciates sense of self worth and nurtures it.
 Maintains standards of personal conduct reflecting
credit upon the profession. Carries out
responsibilities within the framework of the
professional boundaries.
 Is accountable for maintaining practice standards
set by Indian Nursing Council.
 Is accountable for own decisions and actions.
 Is compassionate
 Is responsible for continuous improvement of
current practices.

15. 2. NURSING PRACTICE: NURSE:-
 Provides care in accordance with set standards of
practice.
 Respect individuals and families in the context of
traditional and cultural practices promoting healthy
practices and discouraging harmful practices.
 Treat all individuals and families with human dignity
in providing physical, psychological, emotional,
social and spiritual aspects of care.
 Promotes participation of individuals and significant
others in the care
 Ensures safe practice
 Consult, coordinates, collaborates and follows up
appropriately when individuals care needs exceed

16. 3. COMMUNICATION AND INTERPERSONAL
RELATIONSHIP: NURSE:-
 Establish and maintains effective interpersonal
relationships with individuals, families and
communities.
 Upholds the dignity of team members and
maintains effective interpersonal relationship with
them.
 Appreciates and nurtures professional role of team
members. 39
 Cooperates with other health professionals to meet
the needs of the individuals, families and
communities.

17. 4. VALUING HUMAN BEING: NURSE:-
 Takes appropriate action to protect
individuals‘
 from harmful unethical practice.
 Consider relevant facts while taking
conscience
 decisions in the best interest of individuals
 Encourages and supports individuals in their
right
 to speak for themselves on issues affecting
their
 health and welfare.

18. 5. MANAGEMENT: NURSE:-
 Ensures appropriate allocation and utilization of available resources.
 Participates in supervision and education of students and other
formal care providers
 Uses judgment in relation to individual competence while accepting
and delegating responsibility.
 Facilitates conductive work culture in order to achieve institutional
objective.
 Communicates effectively following appropriate channels of
communication.
 Participates in evaluation of nursing services.
 Participates in policy decisions, following the principle of equity and
accessibility of services.
 Participates in performance appraisal.
 Works with individuals to identify their needs and sensitizes policy
makes and funding agencies for resources allocation.

19. 6. PROFESSIONAL ADVANCEMENT: NURSE:-
 Ensures the protection of the human rights
while pursuing the advancement of
knowledge.
 Contributes to the development of nursing
practice.
 Participates in determining for upholding
own knowledge an competencies.
 Contributes to care professional knowledge
by conducting and participating in research.

20. AUTONOMY
Autonomy means that individuals are
able to act for themselves to the level of their
capacity. It is the right of individuals, governing their
actions according to their own purpose and reason.
Professional nurse autonomy is defined as belief in
the centrality of the client when making responsible
discretionary decisions, both independently and
interdependently, that reflect advocacy for the
client. Critical attributes include caring, afflictive
relationships with clients, responsible discretionary
decision making, collegial interdependence, and
proactive advocacy for clients. Antecedents include
educational and personal qualities that promote
professional nurse autonomy.

21. The following are required for a patient to give
informed consent:-
o Understanding adequate comprehension of
the disclosed information.
o Voluntary agreement free assent,
uninfluenced by external controlling factors.
o Competence adequate decision-making
capacity.

22. The principle of autonomy may be
difficult to apply in patient care when there is
strong conviction on the part of the nurse or
other members of health care team that
respecting self-determined choice is not
really in the best interest of the patient.

23. ACCOUNTABILITY
o Accountability is the process that
mandates that individuals are answerable for their
actions and have an obligation to act.
o Accountability involves assuming only the
responsibility that are within one‘s scope of practice
and not assuming responsibility for activities in
which competences has not been achieved.
o Accountability involves admitting mistakes rather
than blaming others and evaluating the outcomes of
one‘s own actions.

24. The concepts of Accountability have two major
attributes: -
o Answerability and responsibility. Accountability can
be defined in terms of either of these attributes but
answerability for how one has promoted, protected
and met the health needs of the client.
o It means to justify or to give an account according
to accepted moral standards or norms for choices
and actions that the nurse has made and carried
out. It involves a relationship between the nurse
and other parties and it‘s contractual.
o The terms of legal accountability are contained in
licensing procedures and state nurses‘ practice
acts.

25. ACCOUNTABILITY OF NURSING
PERSONNEL
 Nursing personnel are accountable for: -
 1. Providing safe and therapeutic environment for the
patients.
 2. Delivering component and personalized care.
 3. Maintaining adequate supplies of material and equipment
for smooth functioning of the ward/unit.
 4. Maintaining accurate and up to date records and reports.
 5. Maintaining good interpersonal relationships.
 6. Protecting client‘s legal rights and privacy.
 7. Working within ethical and legal boundaries.
 8. Keeping pace with changing health needs and developing
technology.
 9. Delivering care as per standards lay down by profession,
statutory body and institution.
 10. Delegating responsibility appropriately.

26. ASSERTIVENESS
Introduction:
Assertiveness is a tool for expressing
ourselves confidently and a way of saying yes and
no in an appropriate way. I t is considered as health
behavior for all people against personal
powerlessness and results in personal
empowerment. Nursing has determined that
assertive behavior among its practices is an
invaluable component for successful professional
practice. Assertiveness is a style of behavior to
interact with people while standing up for your
rights. means that we‘ll feel more empowered and
more in control of circumstances.

27. Assertiveness offers many benefits:-
 We create health, meaningful relationship.
 There is less friction and conflicts.
 There is increased self respect as well as
respect from others.
 Our self esteem is enhanced and we always
feel in control.
 Our productivity at work and the home
increases.
 There‘s less stress at work and overall
sense of well being

28. LEGAL CONSIDERATIONS
(LEGAL ASPECTS IN NURSING)
Introduction:
Knowledge of legal aspects in nursing is
absolutely essential for each nurse to safeguard
self and clients from legal complications.
Consumers are each becoming increasingly aware
of their legal rights in the health care. It is essential;
therefore, a nurse should know her legal rights and
professional boundaries, and their consequences of
nonconformity. Members of public may become
victim of violence unintentionally even by the gentle
hands of nurse or by the tender touch of a surgeon
or a physician. As a nurse it has become an
important necessity to be aware of the legal
aspects associated with caring and helping people
in the health industry today.

29. NURSING LEGISLATION:
 The legal aspects of nursing are taught and
expected to be kept up on throughout every nurse's
career. Employment as a nurse does not only
require a nursing degree but knowledge of the
medical laws that will apply to you should there is a
misunderstanding or challenge by a patient or their
family.
 A nursing job is something many young people
aspire to but without the legal knowledge behind
them, many hospitals will not hire them now that
legal issues are becoming more and more
problematic.

30.  Legal implications are as follows:
 1. Torts.
 2. Assault.
 3. Battery.
 4. Negligence.
 5. Malpractice
 6. Fraud
 7. False imprisonment
 8. Invasion of privacy
 9. Legal documents
 10. Informed consent

31.  Torts: torts are when others interfere in individuals‘
privacy, mobility, property or personal interests.
 Assault: Assault occurs when a person puts another
person in fear of a harmful or offensive contact. The
victim fears and believes that harm will result as a result
of the threat.
 Battery: it is an intentional touching of another‘s body
without the other‘s consent.
 Negligence: it is conduct that falls below the standard
of care that a reasonable person ordinarily would use in
a similar circumstances or it is described as lack of
proper care and attention carelessness
 Malpractice: failure to meet the standards of
acceptable care which results in harm to another
person,
 Fraud: it results from a deliberate deception intended to
produce unlawful gains.

32.  False imprisonment: it occurs when a client is not
allowed to leave a health care facility when there is no
legal justification to detain the client or when restraining
devices are used without an appropriate clinical need.
 Invasion of privacy: it includes violating confidentiality
intruding on private client or family matters, and sharing
client information with unauthorized persons.
 Legal documents: it comprised:
a) Advance directive: written document
recognized by law that provides directions concerning
the provision of care when a person is unable to make
his or her own treatment choices.

33. b) Do not resuscitate orders: written order
by a physician when a client has indicated a desire
to be allowed to die if the client stops breathing or
the client‘s heart stops beating.
 Informed consent: it is clients‘ approval [or that of
the clients‘ legal representative] to have his or her
body touched by a specific individual.

34. NURSING LIABILITIES AND PREVENT MEASURES:
o In order to protect you from
malpractice suits, nurses must take as many precautions
as they can during their daily shifts. Recording,
documenting and reporting your daily routines and
decisions is one of the most common ways to make sure
you are on track with your patience and in the right.
o All nursing observations should be noted
carefully, describing accurately not only any typical or
erratic changes in the patient‘s conditions, but also any
lack of cooperation, or any other behavioral problems.

35.  Patients complains should be recorded as accurately
and specifically as time and space on the chart would
permit some complaints often provide a clue to the cause
of an accident that might otherwise would have been
difficult to explain.
 Nurse must report through proper channels, any activity
or lack of it, by any subordinates which indicates that
they are not properly trained to carry out the assigned
functions and duties,
 Authorities must be informed regarding any kind of
equipment, materials or supplies, which for any reasons
less than safe for use in the patient‘s care. An alert nurse
will always be aware of the fact that accidents can and
will inevitably occur.
 Insurance protection: there is a moral and practical
necessity for a nurse to purchase good liability coverage.

36. LEGAL RESPONSIBILITY:
o Legal responsibility in nursing means to practice
nursing within the guidelines laid down by the
law of centre/state, statutory bodies and
institutional polices. The main responsibility of
nurses is to provide care based on nursing
diagnosis, prioritizing the needs; planning,
implementation and evaluating the nursing care.
 Nurse provides care to the patient based on
needs, respect, dignity, and right without
considering race, nationality, caste, creed, color
or socio economic status.
 There are certain determinants of legal
framework for nursing practice in India: -

37.  1. Registration: Licensing is a mandatory
procedure for practice of nursing. Registration aims
at protecting patients by providing qualified nurses.
The nurse is responsible to obtain registration in the
respective State Nursing Registration Council.
Employers should recruit only as per the State
Nursing Home Act.
 2. Legal Liability/Act Of Negligence: License of a
nurse can be suspended or cancelled for any act of
negligence or mal practice, following a specified
procedure.

38.  3. Medico – Legal case (M.L.C.): A medical legal case is a
patient who is admitted to the hospital with some unnatural pathology
and has to be taken care of in concurrence with the police and/or
court.
Types of clients which are categorized as MLC in a hospital are:
Road traffic accidents. Injuries inflicted during
brawls/fights, shooting, bomb blasts etc. Suicide. Burns. Poisoning.
Rape victim. Assault. Legal liability/ act of negligence Criminal (IPC)
Civil Under section 304 of Indian penal code (IPC) E.g. wrong
medication leading to death of patient Tort in civil court (Negligence
e.g. not giving railing bed to conscious patient causing fall of patient)
46 Nurses role in a medico-legal case:
 1. obtain complete history from patient or significant other(s)
 2. Inform the police officer/constable on duty in the hospital and the
CMO.
 3. When it is made a MLC. Then record it on the patient‘s case sheet
with red ink at right hand top corner.
 4. Do not give any statement about patient‘s condition to police,
magistrate or media. Only a doctor has to give information.

39.  5. When a patient has to be discharged, inform the CMO.
After clearance from them, then only he/she can be
discharged.
 6. If a MLC patient absconds inform the CMO immediately
and the treating doctor.
 7. No patient can leave against medical advice.
 8. Documentation the care given to patients timely,
accurately and duly sign the nurses notes.
 9. Records and all the documents pertaining to patient
should be handled with care, during the stay in the hospital.
They must be kept safely and should be handed over to the
authorized person as designated by the hospital authority.
 10. Incase death of a MLC; the body is not to be handed
over to the relatives. It needs to be accurately labeled and
sent to the mortuary CMO and/ or police officer should be
informed simultaneously.
 11. Appropriately authority must be informed.

40.  4. Correct identity: A nurse/midwife is responsible to make sure that all
babies born in hospital are correctly labeled at birth and handed over to right
parent. Unknown/unconscious patients must be labeled as soon as their
identity is known. Patients who have to undergo surgery should be
appropriately identified and labeled . Site of operation to be correctly marked
particularly where symmetrical sides or organs there. Operation theatre
(O.T.): scrub nurse has to see all the instruments/ swabs are returned. She
has to say ‗OKAY‘ before closure by the surgeon.
 5. Left Against Medical Advice (L.A.M.A.): Inform medical officer in
charge. Signatures of both patients and witness to be taken as per
institutional policy. 6. Patient’s Property: Inform patient on admission that
hospital does not take responsibility of his belonging. If patient is
unconscious/ or otherwise required then a list of items must be made,
counter checked by two staff nurses and kept under safe custody.
 7. Dying Declaration: Doctor or nurse should not involve themselves in
dying declaration, in case where police records the dying declaration. Dying
declaration is to be recorded by the magistrate. But if condition of patient
becomes serious then medical officer can record it along with two nurses as
witness. Dying Declaration can be recorded by the nursing staff with two
nurses as witness when medical officer is not present. Then the declaration
to be sent immediately under sealed cover to the magistrate.

41.  8. Wills: For this doctor has to be present for he can recode if
requested.
 9. Examination of rape case: Female attendant/female nurse
must be present during the examination.
 10. Artificial human insemination: Written consent should be
obtained from both donor and recipient. Donor and recipient must
have the same blood group. Donor‘s and recipient‘s identity should
be kept confidential. All related documents should be kept
confidential and safe.
 11. Poison case: Do not give either verbal or written opinion. Do
not allow to take photos unless special permission is granted by
appropriate authority. Do not give any information to public or
press. Preserve all evidence of poisoning. Collect and preserve all
excreta, vomits and aspirates, seal them immediately and send to
forensic laboratory at the earliest.

42.  12. Consumer Protection Act(1986): Consumer protection act
was passed by parliament in 1986 to provide for better
protection of the interest of consumers and focuses on
consumer justice through the establishment of consumers
councils and authorities for the settlement of consumers
disputes and matters connected therewith. The scope of the Act
is wide enough to include a vast variety of services.
Rights of a consumer/ patient are:-
Right to safety. Right be informed. Right to
choose. Right to be heard.Right to seek redresses.
Right of consumer education. Nurses role to prevent
complications:
1. Review nursing practice periodically. Update knowledge and
improve skill by attending short term courses, in-service
education and continuing education programmes.
2. Should have complete knowledge of all rules and regulations of
hospital and know their descriptions (duties and
responsibilities).
3. Follow nursing practice standards/protocols.
4. Be a keen observer.

43. 5. Written instructions must have rules and code of
practice laid down to ensure the safety and well being of
patients and nurses.
6. All hospitals must have rules a code of practice laid down
ensure the safety and well being of patients and nurses.
7. Maintain records and reports of the unit properly.
8. Follow 6 R‘s – right patient, right drug, right time and
right route with right technique.
9. Check the treatment order and use professional
judgment before implementing.
10. Do not exceed the limits of nursing procedure laid
down by statutory bodies.

44. CONCLUSION: Every nurse should act as per the
legal guidelines for nursing practice while caring for
patients since negligence may cause a great
distress to nurse, the patient and others, as well as
to reputation of the institution.Every individual is
ordinarily liable for their own negligence.‖ Therefore
nurse have a responsibility of seeing that no harm
comes to their patients and also to themselves.

45.  BIBLIOGRAPHY:
 1.BT Basvanthapa. Nursing administration. Ed.3rd.
Jaypee Publishers; New Delhi. 2000; 474-510.
 2.Chitty Kay Kittrell. Professional Nursing
Concepts and challenges. Ed 4th. Elsevier
Saunders. 2005; 521-72. 3.Indian nursing council.
Teaching material for quality assurance model:
nursing; Ed.1st . Indian nursing council. New Delhi.
2006; 44-50, 62.
 4.Joan L. & Parker. Conceptual Foundations of
Professional Nursing Practice. Mosbys. 1991; 149-
160. 5.Marry Lucita. Nursing Administration.
Elsevier. 2005; 251-57.
 6.Nursing Times Nightingale. June 2007(3); 49-51.
7.Potter & Perry. Fundamentals of nursing. Ed. 5th.
Mosbys. 2001(1);401-23